T'snewstart

As some may know, I have been trying for WLS since August of 2005. Finally my time came and I was sleeved. I was a very active member on ObesityHelp until I found this site. Enjoy the info and videos...
 
The word bougie means "candle" in French. "F or FR/Fr" following a bougie size=French
 
Its just a guide that the surgeon uses to butt the stapler up against, when forming your VSG. The closer s/he gets to the guide the 'tighter' /truer to guide the sleeve is. During surgery the bougie is inserted into your mouth down your throat, towards the end of yer stomach where it meets the pylorus via an esophageal dilator. After the new stomach is formed, the bougie/guide is removed out of your mouth, possibly why some VSGrs complain of a sore throat post op.
 
 
Some surgeons will use an endoscope or other "guide" to size ones new stomach. I read an OH post of a VSGr who's surgeon explained an endoscope is the same size as a 32F bougie...Im not sure.
 
Bougie size determination is between YOU and YOUR surgeon. Discuss size, rationale for size chosen, type bougie and technique used when sizing your new stomach........ PRE-OP!!
 
Some surgeons may "oversew" the staple line giving one a 'tighter' than bougie sized sleeve.
In order for an "oversewn" staple line to affect stomach size it MUST be running or continuous oversewn suture line across majority of staple line not intermittent oversewn nor merely at intersected "junctures" where the surgeon has reloaded the staple gun as majority of "oversewn" techniques (to prevent leaks) are done today. Make sure your surgeon explains what his/her "oversewn" technique is. Do not assume because a surgeon "oversews" you have a tighter than bougie sized sleeve.
 
A bougie is 1/3 mm PER french. i.e to calculate ~ inches 40F bougie 1/3 x 40 = 13.33mm convert to inches = ~.52 inches or ~1/2 inch in diameter.
 
Below are diameters of bougie/ "guides" in inches
 
32F = .40"
 
34F = .425"
 
36F = .45"
 
38F = .476"
 
40F = .5"
 
46F = .576"
 
60F = .75"
 
 
Video 1
 
This VSG surgery video shows a 'red' 34F bougie, one technique in sizing stomach, exised stomach, testing for leaks etc
.http://www.orlive.co...eight-loss-surg ery-gastric-sleeve
Red bougies are older mercury filled ones. FDA is tryin to ban em because of disposal issues (mercury).
 
 
More surgeons will use SINGLE USE disposable sized bougies
 
Video 2
 
In this surgical video Dr. Alvarez shows a disposable 32F bougie and use/technique
 
 
~9-2012
In another Forum, this member's bougie pix is from hospital she works at 1st: 36F, 2nd: 38F on left, 32F on right

 
 
General/ crude comparison chart created by another Forum member


 
 
Standard sized bougies in the US and Mexico are 32F. 32F is the smallest guide a bariatric surgeon in the US may safely use in forming your sleeve. Your surgeon may prefer any size bougie from 32-50F, based on YOU, your height, weight, or perhaps the need for a malabsorptive procedure in the future, inc. 1st step of 2 part DS. Discuss what to expect, rationale for size chosen with your surgeon if this is a concern.
 
LapSF/Dr. Criangle on their routine use of 32F bougies in VSG "Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" .
 
Some surgeons will welcome discussion and your input on bougie sizes. After reading a published journal on the higher incidence of VSG surgically induced GERD (acid reflux/heartburn) in use of 28-32F bougies, it may be wise to request a higher bougie size. However, like all surgeries, we will need years of data to support whether or not this claim is actually true.
 
The History of using Bougies
 
In 2000 the use of 50-60F bougies were standard for VSG when it became a stand alone WLS, as they were the standard sizes of DS bougies, which VSG was modeled after. As the years went by, bariatric surgeons thought..smaller bougie, better restriction, less regain. So in ~2005 an adopted 32F bougie became the VSG standard. Rarely, if ever are 28-30F or 50F and over bougies used in the US for VSG as stand alone anymore. Many many VSGrs do EXTREMELY well with 40F-48F bougies as the guide to sizing their new stomach, losing all the weight they need to.
 
In 2008 study (small poll 135 pts) on Bougie Sizes in VSG seems to indicate at 6 mos and 12 mos post VSG .... 40F and 60F bougies with no significant difference in EWL (eventual weight loss) 2008 Bougie Size Comparison
 
In 2009 study (a large poll) on Bougie Sizes in VSG seems to indicate at 5 years post VSG ... 32F and 44F bougies show exactly the same EWL (eventual weight loss) 2009 Bougie Size Comparison
 
In 2012/13 study (a very large poll) on Bougie Sizes in VSG seems to indicate at 3 years post VSG, a LESS than 40F bougie and GREATER than 40F bougie show no difference whatsoever in EWL (excess weight loss) 2012/13 Bougie Size Comparisons
 
 
VOLUME/GASTRIC CAPACITY in VSG:
 
PRE VSG: Average stomach holds 32-48 oz or 4 to 6 cups per meal
POST VSG (~6-8 months out FOR LIFE) ..new stomach holds 8-12 ozs or 1 to 1.5 cups per meal
(depending on weight/density of foods you eat! can be much less or much more)
 
The length of an adult stomach is 10-12 inches. DNA affects the length of our stomachs, as well as variations in shape. Tall people, for instance are known to have longer stomachs..so makes sense they have a bit more capacity, short people have shorter stomachs therefore less capacity.... so volume/capacity can be influenced by the length and physical anatomical variations of an individual's stomach.
 
Dr. Alvarez explains in this You Tube video about length of an individual's VSG stomach and how it relates
to volume.
 
This limited 2009 study is interesting in looking at gastric capacity in VSG,
just 3 days post op (120 ml=~1/2 cup) compared to 2 years post VSG (250 ml=~1 cup)
http://www.ncbi.nlm.nih.gov/pubmed/19533260
 
At the end (8:28 mark) of this LapSF VSG surgical video shows 1 DAY old (pod) sleeve Xray and a sleeve Xray at 4 years out. It is not clear to me if same pt. or solely to impress the new "normal" sleeve size. Note the "new normal" 32F tightly formed sleeve has dilated/stretched naturally to perhaps triple in size...The video also shows one technique of sizing the sleeve, as well as reinforcement of the staple line (to prevent leaks)
 
This VSG video shows the speed with which LIQUIDS/FLUIDS empty from the sleeve. In normal stomachs fluid empty rate is 5 minutes or less due to space creating a reservoir for large volumes of fluids. In VSG stomachs: fluid empty rate looks MUCH faster than that... youdecide!
 
The COTTAGE CHEESE TEST /CCT (link following) may be helpful to VSGrs that are curious about their new stomachs capacity. It was developed for RNY but an effective tool in VSG as well! I'd suggest waiting until you are on a regular diet before checking. When doing this test PLEASE eat to sensation of satiety - no longer hungry, and absolutely not full.
 
A simpler method, following the basic guidelines and time frame in the link provided... is to place 1 level cup (8oz) of small curd cottage cheese in a bowl and eat from that. Using a measured tablespoon to eat any remaining cottage cheese from the original container. Add or subtract any cottage cheese eaten or not finished using the measured tablespoon. 2 TBS=1oz. Total...the amount consumed = your sleeve's capacity.
http://www.bsciresourcecenter.com/proddetail.php?prod=A4
 
 
STRETCHING in VSG:
 
YOU CANNOT STRETCH/DILATE out your sleeve to anything remotely close to its original size.
 
From LapSF/Dr. Criangle: The removed section of the stomach is actually the portion that stretches the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food.
 
The fundus (inc. majority of stomachs 'body' up to pyloric canal) of the stomach is ALL but removed with VSG.
The fundus is the upper most part of the stomach's greater curvature. The fundus is:
1) the stomach's stretchy/expandable tissue, capable of expanding 2-3xs its resting 'unfilled' size
2) the pre-op 'mass quantities' of food, waiting to be digested, storage section
3) where 70% of the body's grehlin a "hunger hormone" is produced.
 
 
 
Stretching, due to overeating is most common in RNY because more of the stretchy fundus part of the stomach is retained to make the 'pouch', and is usually NOT covered by insurance to correct. Re-sleeving or a need for a malabsorptive surgery post VSG may or may NOT be covered by your insurance plan.
 
Anecdotally, Ive read from select OH VSG members, or according to a/their particular surgeon..overeating will cause your sleeve to stretch out. Ive read/found no scientific data, published or otherwise, to date that says this is a TRUE statement.
 
Since food stays in our stomach less than ~ 3 hours after a meal..common sense tells me food doesn't stay in our stomachs long enough to create 'stretching'. Food once ingested, immediately begins to be churned into a liquidy sludge called chyme through peristalsis in the stomach. This liquidy sludge must be small enough to pass through our very small pyloric valve and into the small intestine for further digestion /breakdown and absorption of 'micronutritents' ...so there cannot be enough pressure for long sustained periods of time in our stomachs to cause it to stretch.
 
 
Post op VSG ... depending upon the amount of swelling/inflammation you have..even a little 'thick/er' dense liquids or pureed foods/mushies may or may not feel restrictive, as you pass through the progression of texture dietary phases ( to promote healing) and onto your regular diet ~2mos post op. ... swelling/inflammation has naturally reduced. Density of meals becomes a key player in restriction. By 1 year out you'll find you can eat more than you could at 2 days post op, at 2 weeks post op, 2 months post op, and 6 months post op. Your sleeve has naturally and fully matured.
Depending on the food..you can eat more or less than the 8-12 oz capacity of a fully matured sleeve.......at any particular meal.
 
Toleration of a food, does NOT make it a good choice!
"just because I CAN...doesn't mean I DO"
 
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The bougie size controversy/wars are ridiculous imo.. 'get a smaller one, you can stretch it out, you're not going to have any restriction, that bigger one is all wrong, you'll re-gain easily years out, my surgeon made mine smaller and I got to goal in 6 months'
...all nonsense DO NOT PAY EM NO MIND!! This is YOUR story! YOUR journey!
 
 
ALWAYS REMEMBER THIS TRUTH:
 
YOUR WEIGHT HAS NOTHING TO DO WITH THE SIZE OF YOUR STOMACH, altered or not!
 
Most important is the quantity and quality of the food choices you ingest post-op

This afternoon I had my one month check up with Dr. Fowler, although technically it is almost 5 weeks. According to his scale, I weighed in at 278. I weighed myself this morning and was 276 on my scale at home (which is a 1 lb difference from his...I already figured that out). So within a few hours I gained a couple pounds, but I'm not worried about it. I had done a lot of cardio and drank a lot before my afternoon appointment. I think I will stick to morning appointments from now on though because I don't like to see the number go up in a few hours ...no matter what the reason is.
 
I was able to ask him some questions that I have been wondering. First, I had a 38 bougie used on my tummy. He said he always uses this size. He used to use anywhere between a 28 and 60, but over the years they have found that a 38 has had the least amount of complications. I was worried this was big and did some research on the net as to what the difference is between a 32 and a 38. Well, it is miniscule. Anyone who is worried that a 38 is too big has nothing to worry about. It is literally the diameter of a pen and a 32? Well just a smaller pen. Compared to the size of the stomach before it is a huge difference! I'm not worried anymore now that I understand how miniscule the differences are.
 
I was also able to ask him about my calorie intake. It has been bothering me for some time that I am rarely hungry and get in about 300 to 600 calories daily. There are others who can eat twice as much as that and had surgery the same week. I was worried that I wasn't getting enough nutrition and that it might stall my weight loss. He basically told me not to worry about my calories. He said I wasn't losing weight super fast so it isn't even an issue. He just told me as long as I am getting my protein, water, and vitamins in that it basically doesn't matter. As to why I am rarely hungry, he said that was a sign that my body is still in ketosis. Yay! I feel so much better. I will not be forcing myself to get in more calories than my body wants anymore. I am just going to listen to my body. One more thing I have to work on is not eating until I am full. I want to learn how to eat until I am satisfied which requires me eating super slow. I still haven't mastered that one yet! But that is my goal as far as eating goes.
 
I joined the gym today! Yep, I finally got down to it. I have had a gym membership pretty much my whole entire life except for the past two years. I canceled it because I just wasn't using it. Well, I joined. I actually sat in the car for a good half an hour just staring at the gym. I had a little anxiety about walking in there. Is everyone going to look at me? Are they going to be rude to me? Well I got over it. I just said in my mind I need to do this for me. I got signed up and did my 60 minutes of cardio. For me, it is so much easier working out in a gym setting. I hate working out at home. I love being able to focus on no one, but myself. I love blasting my music and tuning the whole world out. It is my peace and quiet time. I think that is why I used to love going to the gym before. It is almost like meditation for me. It was exciting and I am not even tired.
 
So all in all, today was a good day. No, it was a great day! I am so looking forward to my weight loss with my tool and my newly added gym membership.

This is such a personal journey for each and every person who choses weight loss surgery. I find that like everyone else this is not my first time at the rodeo, so to speak, when it comes to losing weight and trying to be healthy. We all have our demons and those who say they support us and want the best for us. But when the sun sets and it comes down to it the only person who can do this is looking right back at me in the mirror. Since I know this is such a personal journey, I have decided that the best way for me to deal with this is to reach out to those people like me, on this website (as my dog is getting tired of me talking to him and the cat just ignores me!). Let me explain who I am and why I am here....
 
I am the youngest of three children, the baby and the only girl. Now most people would say wow you are the spoiled one, that I got away with everything and that I could do no wrong. This is the furthest from the truth in my case. I came from a loving family, and a mother who was home and when it comes down to it I had a great childhood. I never wanted for anything, I never knew what it was like to go without, and this included food. In defense of my mother, she never had to worry about her weight as she was blessed with that metabolism that allowed her to eat anything. Until I came along, she was cooking and feeding a family of all men, which meant the more food the better. We were all active and played sports and I was no exception. I played softball, soccer, volleyball and spent the summers swimming and even swam on the country clubs swim team. But to this day I hear that I don't eat enough. Really!! Let's see I got to this size by eating broccoli, uh I think not. There was an endless supply of twinkies (and yes I will miss them) pepsi by the case (and in bottles my weakness), chips and candy and we were never denied. Now, I am not blaming my mother, she just didn't realize nor did I. She sent me off to fat camp when I was 9 because I was in "husky" clothes (and the person who classified clothes as husky should be shot!), she had me checked out by physicians for "gland problems", who told her I was very healthy and if i lived in the islands I would be considered gorgeous and sought after by men (well we weren't moving and this devestated my mother I think more than me). From that point forward it was a tsunami of weight watchers, nutri systems and fad diets. I never had a problem with boys or men, I am everyone's friend and love to make people smile (the curse of a fat person to be accepted), in fact I was part of the in crowd in high school and college. I married had a child and the divorced and none of this was because of or in spite of my weight. So this only fueled my RA (I will explain later), I kinda wish I had I think I would have woke up long ago.
 
I look back and say, ok I have a great sense of who I am (I work in a level 1 trauma hospital's ER and love my job) and what is right and what needs to be corrected, I just haven't been able to correct it, until now. I never knew the why, I never really knew what got me to the massive weight of 352, and yes for me that is massive. Well the why is rather complicated, yet simple, and took me a bit to figure out. It is simple the why is because, simply because. Ok, stop laughing but that because has a very strong foundation. I am this size because I never stop eating the wrong things, because I wanted everyone else to correct my problem, because I would never get on a scale or acknowledge my weight, because I wouldn't admit nor did I see that I was overweight, this is my RA. Now let me explain that one. I used to look in the mirror and I never saw an overweight person. I know that sounds strange but I think I have a disease that has yet to be identified, a type of reverse anorexia (aka RA). You know it's an eating disorder of an obese person, just as devestating and it was fueled by not just my friends family and physicians (yes I had numerous physicians tell me I didn't need to lose weight, that I am healthy!) when deep down I knew better. I could keep going and going but I think you get the idea by now, so I am obese because, simply because.
 
Well, I snapped out of it, what caused me to snap out of it I don't know but I did. I have no co-morbidities I am healthy and if you looked at my medical records (with the exception of my weight) you would see an above average healthy female, so it wasnt my health. I am going to have this sleeve as I know that I cannot stay this heavy and this is my only way. If I don't my health will decline and I will become ill if not die, and I don't no I won't let that happen before I have lived a long long long life. I now have no problem saying my weight to those I trust, I see a fat person in the mirror when I look now (oh and I don't like what I see!). I have researched this surgery until I feel like there is no way I can fail. I have researched my physician and hospital and have confidence in his abilities and the capabilities of the hospital. I just now have to get my insurance and my life in place to succeed. First, I have to finish a year (only 6 mos more to go) of nutritional visits with my primary physician before my insurance will approve my surgery. I will finish this 12 mos requirement in July. I thought that this process would take forever, but I do not see that being the case, the first half has flown and now I am on the downhill slide.
 
I will use this blog to express my feelings and just get it off my chest, I am not sure if anyone will read it, or if you are reading this then I hope if nothing else it lets you know you are not alone in this battle. Until next time

I am 6 weeks out, trying more and more foods and not really having difficulty with digestion. I have had a poor appetite and my taste buds have been off, everything has tasted bland and not near as good as I seem to remember or believe. I had only lost 19 lbs and was feeling rather disappointed in myself and the process. Then I realized I have been eating, not like a healthy life style but as if I were recuperating from a surgery and just making do
waiting for everything to return to normal. I had not been getting in my protein. My water intake was not adequate, my carb ingestion way too high.
I had to stop and think duh.......this is not waiting to get back to normal, this is my new normal and this is for life! What the hell did I do this for if I was not going to develop the healthy habits I had planned on.
Light bulb moment. For a smart woman I sometimes take awhile to get it.
 
So yesterday and thus far today, made my water requirements, protein is up, carbs down and exercised too!!!!!!! look out baby I am back in the game and I intend to be a winner!!!!!!!!!!!!!!!!!!!!

Hi all. Well I had my surgery two days ago. I came home last night. I feel so much better today than I did on the day of surgery. I hope it continues to improve at this rate. Right now I am still on clear liquids. Monday I can start full liquids. It seems like I have taken very little in but yet I am not dehydrated. Two ounces of jello and a sugar free popsicle. Also water and some juice. I want to be so careful not to develop a leak. Right now sometimes I get a gurgly feeling when I drink. Do we always have this or is that something that subsides with time?